Individual
LASHASTA NICHOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2873 TITUS AVE, OMAHA, NE 68112
(405) 924-3572
Mailing address
2873 TITUS AVE, OMAHA, NE 68112-3231
(405) 924-3572
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/12/2025
Last updated
02/12/2025
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